EU workers in Scotland's social care workforce: contribution assessment

5. Qualitative findings

The qualitative research, discussed in this chapter, provides for a fuller understanding of the survey results and of care service managers’ and workers’ perspectives and experiences of recruitment and retention – including in relation to the UK’s decision to leave the EU.

Recruitment

Although most care service managers who took part in the survey had not experienced increased difficulty recruiting and retaining staff in the last 12 months, the qualitative research confirmed that staffing was nonetheless a significant challenge for the sector. Indeed, recruitment specifically was commonly cited by the managers interviewed as the main such challenge, alongside funding (or a perceived lack thereof) and the generally difficult nature of care work.

Managers discussed recruitment challenges in terms of both the numbers of applications they received for posts and the quality of candidates. On numbers, and consistent with the quantitative findings, there was particular mention of a lack of applicants for nursing posts – "nobody seems to apply" was how one participant put it – which had left several services reliant on agency staff, and facing budgetary pressures as a consequence.

"It puts great financial strain on the budget as agency staff are so much more expensive."
Care home manager (private sector), North East

In terms of the quality of candidates, participants commonly said that those applying to their service often had no suitable qualifications and, indeed, appeared to see care work as an easy option or something "anyone" could do. Several went further, expressing a view that some candidates appeared to apply, not because they wanted to work in the service, but simply to make the job centre think they were actively seeking work. The consequences of this were two-fold: many of the candidates either failed to make it to, or past, the interview stage; and services had to "waste" considerable time and energy ‘sifting’ for more suitable candidates.

"[The work is] not taken seriously enough…people think it's just looking after babies…We're looking for a lead practitioner and it's quite tricky. You get maybe 10, 12 people come forward for the position. Out of that 10 or 12 maybe two were actually qualified."
Day care of children manager (private sector), North East

"I think what’s happening is there is so many people unemployed at the job centre and they are told to go to these interviews…they basically see an advert for a carer, think, ‘och, I can do that’, then when I actually tell them what’s involved in the job and show them round, they think, ‘Oh, I don't think that's for me."
Care home manager (private sector), South West

"We've got people who say they have got seven years care experience but there is nothing on their CV. We also have people that will apply, you invite them for an interview and they don't appear, and they reapply and reapply and in the end we block them because they are playing the system. "
Care home manager (Voluntary sector), North East

Apart from a lack of genuine and suitably qualified candidates, participants identified a number of other factors they believed had contributed to recruitment challenges in the sector, and their own services specifically. Chief among these was low pay – combined with wage competition from other providers. One care home manager, for example, described how other homes in her area that were particularly "desperate" for staff were offering around £18 per hour; a rate she was unable to match. Other managers made spontaneous reference to higher rates of pay offered by nurse agencies.

"I'm actually struggling with my activity staff just now. I should have four and I’ve currently got one. The pay is minimum wage, and it's a hugely challenging job...it's bad enough to work for the Living Wage."
Care home manager (private sector), South West

" Some care staff are getting paid £8 an hour. We pay £10, you know, £12 at the weekend…it's a huge difference if you're paying bills and things, it's quite a difference."
Nurse Agency Manager (private sector), Highlands and Islands

Managers in more rural or peripheral areas cited their location as another factor contributing to recruitment challenges. They described how poor public transport connections meant their service was difficult to get to without a car and therefore less desirable as a place to work than more ‘connected’ services.

" We're kind of in between a city and a village…it's one of those places you go through as opposed to go to. So we find that some people will come from villages roundabout on their way into town and they will drop children here [but] if the staff member doesn't drive, then it does limit how you recruit."
Day care of children manager (private sector), North East

The UK’s decision to leave the EU was cited spontaneously as a factor impacting on recruitment by a small number of participants. These were all managers of services, the specific circumstances of which meant they had a long tradition of employing, and/or were unusually reliant on, non- UK EU staff. One such service was a care home for people with learning disabilities that was located in a relatively rural area and thus had a high proportion of residential staff. These staff had traditionally come from the EU but applications from EU workers had been "drying up"; a situation the manager attributed to the UK’s decision to leave the EU and a consequent "negative air about working in the UK." He described how local people were less keen to take up residential posts, so, "for the first time since [he could] remember", there were vacancies in his staff accommodation. Ultimately, he felt the situation was limiting his service’s ability to "grow, expand and develop."

The other services that were unusually reliant on non- UK EU staff and consequently saw Brexit as presenting recruitment challenges were Montessori schools. A manager of one such school described how Montessori was much better known and respected in continental Europe (and further afield) than in the UK – and, indeed, that nursery care generally was something of a higher status profession there than here. This meant that she received more job applications from EU than UK workers, and that EU candidates tended to be "higher calibre".

" All our EU national staff have degrees in something related to early years education, because they have a more general degree in Greece and Spain and Germany where you can actually focus on pedagogy, which doesn’t exist in Scotland...In Scotland if you have a brain you go into academia or teaching older kids, you don't go into nursery teaching because it is really poorly paid…We do get Scottish people but it's kind of like a tenth of our staff."
Day care of children manager (private sector), East

This manager went on to comment that if her service was no longer able to employ non- UK EU staff it "just wouldn't function."

Retention

Consistent with the survey findings, few managers who took part in the qualitative research reported problems of staff turnover at their service. That said they were sometimes quite qualified in their comments, saying, for example, that there was "room for improvement" or that their situation was "not as bad as some".

Further, they often described having two broad ‘streams’ of staff: an older grouping that had been with the service for a long time (usually between 10 and 20 years) and a younger grouping, members of which tended to stay for shorter periods, whether because they proved not to be suitable for their roles (for reasons described above), because they found the work too challenging or because they saw it purely as a ‘stop gap’ – for example, because they were studying or travelling. There was a sense from some of the interviewees that the number of staff not up to the job, or finding the work too challenging, was increasing somewhat.

" We are getting a lot of kids in who are at Uni and they want part time…they don't often tell you they are at Uni, and then they will say, ‘Right, I'm going to Uni full time now, I need to leave.’"
Care home manager (private sector), South West

" We are actually finding just now that staff have no inkling of what it’s actually like to come and work and be responsible and the need for reliability…They think, ‘’och, I'm not going in today; I'm just not going to bother’, and they don't understand the knock-[on] effect on that in a care home."
Care home manager (private sector), South West

Aside from such issues, pay was commonly identified as another factor contributing to staff turnover. Specifically, managers and workers recounted occasions when members of their team had gone to work for higher paying providers – for example, a few private sector managers and workers said that some of their staff/colleagues had gone to work for local authorities. Another manager said members of their staff has been attracted by the "lure of what they could be paid in a nurse agency."

" Having better pay maybe wouldn't get so many people to leave for the council nurseries and would get the staff staying for longer at least, and the consistency of the care would be better as well because there is so many changes it can affect the children."
Day care of children worker (private sector), East

Brexit was not mentioned spontaneously as a factor currently impacting on retention. However, there was reference to other policy and broader societal developments that were putting pressure on staff and services generally.

Care home managers spoke of increasing demand for their services arising from both the ageing population and the government’s emphasis on independent living, both of which meant that the residents they took on had increasingly complex care needs. Nursery staff, meanwhile, spoke about the government’s focus on increasing funded childcare hours and the challenging resourcing implications of this. They also referred to increasing "paperwork" and the demands of the regulatory regime that produced added pressures.

" There is just not enough beds for the need that is out there… People are staying out in the community longer. People then are living longer, but their needs are going up."
Care home manager (private sector), North East

" There is that tricky thing as well with the government trying to provide more funded hours for children…we know a lot of proprietors [in England] have had to close down because it is impossible to provide those hours on the money that they're offering.
Day care of children manager (private sector), East

More generally, there was repeated reference to challenges wrought by austerity and an associated perceived lack of funding for the care sector, which was seen as impacting on the quality of services provided – as well as tying managers’ hands somewhat when it came to dealing with any staffing challenges they were facing.

" What it all comes back to, you know, is money though…If care in Scotland was [better] funded…God, we could lead the world on care, but we're working on tight staffing numbers."
Care home manager (voluntary sector), East

Responding to recruitment and retention challenges

Generally, managers felt that difficulties in recruiting staff were having a negative impact on their services. There was a sense that such challenges were not only compromising the provision of care but also putting a strain on their time and resources.

" If you have got 21 people and you need five people to look after them and you’ve only got three, care is going to suffer…On a unit like that you can’t have any less than three carers, but sometimes we would have to work with one."
Nurse agency manager (private sector), East

Similar views were expressed by the workers interviewed. While all spoke very positively about their services and caveated any concerns they expressed with a resounding optimism, they were clearly nonetheless acutely conscious of staffing pressures. In some cases, workers explicitly mentioned staffing shortages in general or, a lack of specific types of staff, such as nurses. In others they made direct reference to ongoing recruitment struggles in their organisations. One employee reported frequently asking her manager to "organise" more staff.

" Well, think it is that you're always needing nurses. We do have some of the full-time nurses and band nurses, however there's still not enough, but I am sure that our recruitment will work out that."
Care home worker (private sector), North East

" When we've got any problem with short staff we can speak to [my manager] all the time: ‘please can you organise for us more staff’ because it's difficult when we are short staffed."
Care home worker (private sector), North East

Not all of those interviewed regarded the recruitment challenges they cited as a concern, however. Some managers highlighted the transient nature of such challenges, commenting that difficulties came and went intermittently. They perceived the fluctuations in numbers of suitable applicants as somewhat random, unpredictable and not necessarily a growing problem.

" Right at this minute I am completely staffed. All of a sudden there seemed to be available staff out there."
Care home manager (private sector), North East

" I don’t know if it depends on the time of year or whatever."
Day care of children manager (voluntary sector), North East

Although retention was not perceived to be a major issue on its own, it was seen as exacerbating staff shortages resulting from recruitment difficulties. Some of the EU workers interviewed described feeling unsure as to whether staff members who had recently left their service would be replaced. A manager of a private sector nursery felt that retention issues were compromising the quality of care as staff changes were unsettling for the children.

" It is not good because we [have been] short staff[ed] for a while. You never know if you get somebody quickly or not."
Care home worker (private sector), North East

" Yes, some girls have gone off and done other things and we've just not [been able to] replace [them]."
Day care of children manager (private sector), North East

Most managers that had encountered recruitment or retention challenges had taken some steps to try to address these. A range of such steps were cited with a corresponding diversity of outcomes and impacts.

The single most common action was the use, to varying extents, of agency staff. However, while this was helping to address recruitment issues in the short-run, participants commented that it was not a viable long-term solution due to the greater costs associated with employing agency staff, as mentioned above. One private sector care home manager went as far as to suggest that his service may be forced to "downsize" as a result of reliance on agency staff.

In terms of longer-term steps managers had taken to try to address recruitment challenges, the most commonly mentioned was enhancing or increasing their service’s training offer. Managers stated that they had taken on greater responsibility for training new staff to widen the pool of suitable candidates, for example, by providing SVQ L2 training and, in some cases, offering specialist training in conditions such as dementia. Managers in the North East referred to an effective training scheme their service was part of that had been developed by staff at Robert Gordon University.

" If we came across a candidate that actually maybe didn't have quite the required qualifications we would be looking to put the training in place to get them up to the standard that you need."
Day care of children manager (private sector), North East

Other, less common strategies mentioned were more widespread advertising of positions both on- and off-line, and more targeted recruitment drives at universities, colleges, hospitals, job fairs and job centres, to increase the likelihood of suitable candidates applying.

"We advertise in job centres, we advertise at job fairs, we advertise at hospitals and colleges and we advertise online."
Care home manager (voluntary sector), East

" We've been sort of advised now to move on to the job centre and actually say, ‘right, this is what we're looking for’, rather than just letting anybody apply for jobs."
Care home manager (private sector), South West

" We've used a site called Workable from head office and that's got it out to quite a few different people, because that automatically puts it on different web[sites], like Indeed and Total Jobs and things like that, and I think that did help a little bit."
Care home manager (private sector), North East

Managers for whom recruitment had not presented significant challenges in recent times tended to explain this with reference to their having pursued some of the above-mentioned strategies – including word-of-mouth publicity, and targeted recruitment via universities. Others explained it with reference to the high profile or strong reputation of their business.

" I think it is targeting areas…target the universities where people are doing that course or they are doing similar courses that show that they have got an interest in that kind of field anyway."

Day care of children manager (voluntary sector), North East

" Our home has just got one of the top 20 care homes in Scotland, so I think that in itself, when people go on to look for care homes in [this local authority] we are the very first one that you see. So because of that I think people do then think, ‘oh, I want to work there’"
Care home manager (private sector), North East

Those managers who felt retention was having an impact on their service, had taken various steps to try to limit staff turnover. These included enhancing the induction process to include monthly one-to-one meetings with staff members to help them settle in; and improving pay and other conditions, such as making holidays more flexible to accommodate non- UK staff who may wish to visit their families abroad for prolonged periods. They felt these strategies had been largely effective.

" Flexibility with their holidays and their off duty. A lot of them would prefer to go home for quite a long spell of time and that can mean six weeks of holiday at one time or longer."
Care home manager (private sector), North East

Similarly, amongst staff who had no retention problems, common explanations offered for this were the collaborative and communicative working environment, competitive rates of pay, and training and development opportunities.

" We have lots of meetings, whether it be flash meetings or whether it's proper staff meetings in different areas, we broke the areas up so we're having meetings for nurses and then meetings for the domestic, and meetings for the kitchen, and just constantly feeding back to them…I think we've got a good training scheme in place now, a lot of courses that they can go on and improve their skills."
Care home manager (private sector), North East

" It does come down to a better rate of pay [and]...we are quite an open nursery where we encourage [staff] if there is any issues to come and speak to me in the first instance, so we try and keep it very proactive as opposed to reactive, and I think just kind of all working together and trying to build a team ….We do a lot of in-house training. We utilise the training that Aberdeenshire council provide and we also utilise obviously the apprenticeship training as well."
Day care of children manager (private sector), North East

Brexit and the contribution of EU workers

While only a small number of the qualitative participants spontaneously identified Brexit as a factor currently impacting on recruitment and retention in the sector, more were concerned that it may impact this way in the future. As might be expected, managers whose services had a relatively high ratio of EU to local staff were the most likely to express this concern.

" It concerns me, just [because of] the level of staff that I have that have come over [from the EU] prior to this and the difficulty in filling positions with local people."
Care home manager (private sector), North East

" Obviously my concern is does that now mean that they are no longer allowed to be here? I think having kind of looked into it my understanding is that if they are settled it's fine. But it's more for new people looking to kind of come in."
Care home manager (private sector), North East

" I think there is a concern because if we lost that pool of people then I think it would be a massive loss to the care sector."
Care home manager (voluntary sector), East

There was a sense in which some managers felt the contribution of EU workers was greater than their basic numerical representation in the workforce might suggest. Two separate points were made in this regard. First, it was noted that in some services, EU worker were more likely than other staff to be full time and/or residential; in other words, to contribute a higher overall number of hours’ work.

Secondly, and in more qualitative terms, managers spoke of their EU employees’ strong "work ethic", exemplified through a willingness to ‘go the extra mile’ to get the job done and to continually learn and develop. Similar findings have been reported in other recent labour force research. ^[27]

" They have made a proactive choice to come to the UK to work in the sector so they have an energy and enterprise about them."
Care home manager (private sector), East

" [ EU workers] are extremely hard working; their work ethic is incredible. I'm not saying that the locals aren't but it's less obvious."
Care home manager (private sector), North East

" They seem to want to work and to learn and if I put a training thing on they are usually some of the first ones to have gone on there and completed it. They are really keen to improve."
Care home manager (private sector), North East

Relatedly, managers sometimes said that non- UK EU workers appeared to be more motivated than other staff by an "ethos" of care (rather than by more material considerations), and that this was manifest in a high level of commitment to their work. Comments made by workers themselves when they were describing what attracted them to the sector confirmed this to an extent.

" They tend to be very passionate and caring and are all of high quality."
Day care of children manager (private sector), East

" They are less motivated by salary and flexibility of hours than local staff, and more by the ethos and philosophy of the service."
Care home manager (private sector), East

" In Poland I was an accountant but I wanted a change of direction and to work more with people…and to help them in their lives."
Care home worker (private sector), East

" I like to look after [the residents]…looking after other people just gives me this feeling that actually I'm doing something good when I cannot look after my own family."
Care home worker (private sector), North East

Less commonly, there was reference to non- UK EU workers being more highly qualified and/or experienced than local applicants. This perspective was advance mainly by managers of childcare services, who, as well as describing how their EU workers often had specialist degrees in childcare or in teaching, highlighted other unique skills they brought to the classroom, not least the ability to speak and teach in different languages.

"[They have] good quality CVs and their interviews are always of a very, very high quality."
Care home manager (voluntary sector), East

" They can speak Polish and Spanish to Polish and Spanish children in the nursery."
Day care of children manager (private sector), East

" Literacy is a huge thing at this age, and so we do quite a lot of songs in different languages, so having the staff that have that as a mother tongue is brilliant."
Day care of children manager (private sector), North East

For their part, workers too expressed some concern about Brexit. It was common for them to say that they were not sure how their residency or work status might be affected, and whether or not they would be able to stay in the UK.

" I don't think it's been properly explained what is going to happen so, yes, so there are some concerns but it's uncertain."
Day care of children worker (private sector), Highlands and Islands

" I'm worried that things will change and if I go back [to Poland for a visit], I might be declined entrance [to the UK]".
Care home worker (private sector), East

One of the workers was married to a non- EEA citizen who worked in the same service as her, and she noted that his residency status was entirely dependent on hers. The manager of her service made the same point and commented that circumstances such as this meant the potential impact of Brexit on the sector could be greater than might be assumed simply by counting the number of non- UK EU national workers.

A minority of workers were unconcerned about Brexit – though this appeared to be based on their simply assuming that "everything will be fine" because they had been in the country for a number of years or because they had bought property here – rather than on a more informed awareness of the UK Government’s and European Commission’s current position.

" I'm not worried about Brexit, nothing to worry about; the law doesn't work that way, I'm quite sure. I was welcomed to the country, so nobody will get rid of me."
Care home worker (private sector), East

" I don't think that somebody move Polish people from Scotland when you've got your private house or flat, you've got a job, you stay here for a long time, I don't think so."
Care home worker (private sector), North East

All of the workers interviewed were keen to remain in Scotland for the foreseeable future, often commenting that they regarded the country as their "home." All had begun considering applying for UK citizenship, though there was evident confusion about the temporal eligibility criteria. Further there was concern about the perceived high cost of the process, with a couple of participants implying this might be prohibitive for them.

" I will be three years in two months here and my family in another two, so I'm allowed to [apply for citizenship] after three years being here."
Care home worker (private sector), East

" I might [apply for citizenship] in a few years' time. I'm not allowed yet, I need to be in the country over six years. But it costs quite a lot of money, about two grand for getting that done, and obviously you need to pass a lot of tests and the tests are expensive too. Because it's so expensive then I [stopped thinking] about [it]."
Care home worker (private sector), East

Awareness of ‘settled status’ as an alternative to citizenship was low among the workers interviewed – just two of them had heard of this option.

Information needs

As is evident in the foregoing discussion, both managers and workers displayed at best a limited awareness of the UK Government’s and European Commission’s current position with respect to the future status of EU workers in the UK. Indeed, it was common for both audiences to observe that "nothing had been agreed" or "nobody knows what’s going to happen." There was repeated reference to a lack of information on the subject that might enable services and workers to plan ahead.

" We're not getting any information at all about what Brexit even is. I feel very disconnected from it as an employer…I honestly think that people are just like, ‘It's not going to happen’…It's not been widely discussed; certainly, within the teaching sphere, we have all just been like, ‘of course we're not going to [leave the EU], that's ridiculous’...or else just paralysed with not knowing what to do."
Day care of children manager (private sector), East

" I don't think there's enough advice being given out, you know, it's very much kind of ‘see what happens’ at the minute. I think there is probably a lot more research that I could be doing as well but when you're already busy..."
Care home manager (private sector), North East

" I don't think it's been properly explained what is going to happen and/or explained or already discussed so, yes, so there are some concerns but it's uncertain."
Day care of children worker (private sector), East

Among managers there was specific demand for more information on what employers should currently be doing in respect of their non- UK EU workers, as well as what "staff could do to remain and what the cost implications were of that and what the government was going to do to cover those costs". One manager suggested that the Scottish Government should consider reinstating a visa scheme for EU nationals along the lines of the former ‘Fresh Talent – Working in Scotland Scheme’, to help ensure the flow of workers to the country.

In the perceived absence of information and planning from government, none of the managers interviewed had formally taken steps to prepare for Brexit – though they commonly described having shared with their EU workers any information they had received on the subject or attempted to reassure them that they would support them to remain in Scotland in whatever way they could. This was very much reflected in comments made by workers themselves.

" We put posters up and things, we quite often get posters about it saying, ‘go to such and such’, and we’ll put phone numbers up, and I do managers, surgeries so that if they have got any worries, they can come and talk."
Care home manager (private sector), South West

" It's trying to make sure that we are supporting them, because we don't want to lose them….Just making sure that they know that we are here if they need any help and if we can help them in any way we will."
Care home manager (private sector), North East

All but one of the managers said that current uncertainties around Brexit had not made any them less inclined to recruit EU workers. The exception was a manager of a nurse agency, who commented that it would "depend on how much extra work it creates or how difficult it's made…agencies might struggle with that a little bit."

Looking to the future

Managers were asked how they saw both the sector overall, and their service specifically, changing over the next five years. Responses tended to be negative or neutral, particularly in relation to the sector as a whole.

" The sector is on its knees. It's crisis time."
Care home manager (voluntary sector), East

" How do I see it? With lots of problems financially if we're not careful. If not, collapse, if we're not careful."
Care home manager (private sector), North East

Indeed, very few managers had a positive outlook for the sector or their service over the next five years. Policy changes, financial problems and recruitment issues, as described above, were the main reasons cited for this.

Both managers and staff were also asked what they thought could be done to attract more prospective employees to the sector. They commonly suggested that there should be a focus on the meaningful and rewarding nature of the work, and the impact it can have on people’s lives. Those working in the childcare sector mentioned the ‘lifelong’ impact their work could have.

" You would want people to come in, know that what they're doing is really, really important. The impact that this has on a child growing up and progressing through the rest of their [life]…what we do now is going to affect these children in their 20s, their 30s, their 40s."
Day care of children manager (private sector), North East

" I would highlight the importance and reward of the work, so people who work in childcare feel, I think, rewarded from the children…we can make lots of changes for the future. It's great to see the children developing."
Day care of children worker (private sector), South West

" It's your approach, and how you approach people with dementia and the fantastic response you’ll get if you just do it right…If you're willing to learn to do that and put your life into that, then it's such a challenging and rewarding job though…the rewards outweigh the challenges really."
Care home manager (private sector), South West

In addition to the rewarding nature of work, participants felt there should be more of an emphasis on its being enjoyable and varied.

" The fun that can be had in the job!"
Day care of children manager (private sector), East

" No two days are the same."
Day care of children manager (voluntary sector), North East

The opportunity to learn new skills – be it through training or on the job learning –was another suggested area of focus in any messaging. There was a sense that care and related roles were becoming increasingly skilled and that the sector provided access to a wide range of training opportunities.

" It's a great place to work, it's good to gain different skills. It's excellent just to learn from each other because we are all different. We can all learn something new every day."
Care home worker (private sector), North East

" I think to attract people…I would say it's the state of the nursery environment and what we're doing… and then over the years we just then address things that we need to like training and things like that, but it's all there for people."
Day care of children manager (private sector), South West

Finally, respondents suggested emphasising the flexible nature of the work, made possible by the fact that some types of care needed to be provided 24 hours a day, seven days a week.

In terms of other measures or changes that might encourage more people to work in the sector, better pay, particularly for frontline staff, was frequently suggested by both managers and workers. There was a consensus that the pay did not reflect the level of responsibility and "emotional labour" often attached to the work.

" They need to look at the wages because I think those that are doing the most hands on care are probably least paid."
Day care of children manager (voluntary sector), South West

" From my point of view, I'm working as a senior nurse assistant and I do get a lot of responsibilities…it's almost the same job role [as a nurse], and I'm on about half [the] wages…you can get better paid in a shop."
Care home worker (private sector), North East

One childcare manager went so far as to suggest that increased pay might also have a positive impact on the quality of work.

" As much as these girls have gone into [the job] knowing that it is never going to make you rich…I think it would be nice just for them to be rewarded for the work that they do. I think if they were paid accordingly you would find that maybe there was a bit more effort put into their day to day tasks."
Day care of children (private sector), North East

Improvements to the overall benefits package – including sick pay, the provision of uniforms free of charge and payment of registration fees – and an enhanced training offer were similarly highlighted as changes that could make the sector more attractive. There was also reference to "small things" that might similarly make a difference, such as providing staff with hot meals during their shifts.

" Do you get sick pay? Do you get training? There are all these extra things that if the company is offering that, then that's all part and parcel of the pay that you get because a lot of companies out there will say they are giving more pay per hour but you've got all your training that you have to do that you don't get paid for and they don't provide. You pay for your own uniforms, all these things mount up."

" It's £120 a year to pay to be on the register. We pay that back to them, so that attracts people to the jobs…£120 a year is quite a lot of money." ^[28]
Care home manager (private sector), South West

While, as noted above, there were those who felt the caring professions were becoming increasingly skilled, others felt that there was scope for further improvement in this regard to make more formal career pathways available.

A final, related theme raised spontaneously by participants concerned the profile and public perception of the sector. There was a sense that the sector had a generally low profile and was considered low skilled and that this needed to be challenged to encourage more, and higher quality, candidates to apply.

" We have to have a change of how people see nursing homes, especially nurses, …it's not [something that you do] because you can't do anything else. I think just being given a better public view of what we offer and being recognised."
Care home manager (private sector), North East

" It's how you promote the sector as a career in schools. It's not seen as a desirable sector to move into and the quality of candidates that tends to apply isn't what we require."
Care home manager (voluntary sector), East

Summary

The qualitative research confirmed that recruitment and, to a lesser extent, retention, were presenting significant challenges for managers in the care sector and, indeed, their workers.

Recruitment and retention difficulties were commonly explained in terms of both a basic shortage of applicants, particularly for nursing roles, and, in the case of people that did apply, and that sometimes went on to take up positions, a lack of relevant skills, experience or aptitude. Low pay was also seen as a contributing factor and may in part explain the greater difficulties experienced by private sector services, evident in the quantitative data – participants highlighted that pay was often significantly lower in these services that in local authority run establishments.

Strategies that managers had implemented to address recruitment and retention challenges, and that had proven effective, included improving their pay, conditions and training offer; being more strategic in their approach to recruitment; and ensuring a communicative and collaborative working environment.

The qualitative research also confirmed that Brexit appeared to have had a limited impact on the sector to date but nonetheless was a source of concern for the future, with both mmanagers and workers of the view that little had yet been decided. Reflecting this, there were repeated calls for more information on the matter such that both managers and workers might begin planning accordingly.

Beyond this issue, the qualitative research highlighted other ways in which the sector might best be supported to meet current, and potential future, recruitment- and retention-related challenges. Asked what they thought could be done to attract more workers to the sector, manager and employees suggested:

• campaign work to raise the profile and reputation of the care sector – such that more people are encouraged to consider it as a career pathway – with messaging focusing on: the importance and rewarding nature of the work; the provision of training and the opportunity to learn new skills; and the flexible hours available in many types of service

• higher pay for workers at all levels, but particularly ‘frontline’ staff

In addition to these suggestions made by participants themselves, the qualitative research pointed to an evident need for more guidance for managers on effective recruitment strategies to ensure higher quality applicants and thereby reduce the burden of the process on services; as well as greater sharing of best practice in respect of training, development, and other strategies to promote retention.